392 DYSTOCIA. 



resource not without danger, to which we should not under any pre- 

 text resort, except in case of indispensable necessity. 



897. Bleeding has always enjoyed much favor among obstetric 

 physicians: Mauriceau, De la Motte, Puzos, &c. have repeated it 

 six, eight, ten, seventeen and even as much as eighty-six times 

 in one pregnancy in the same woman! The loss of blood is al- 

 ways useful where there are signs of congestion about the head, a 

 strong pulse, or any signs of pletliora. The blood is sometimes 

 drawn from a superficial vein, sometimes by means of leeches or 

 cups, and at others by all these means together. Except where 

 there is some particular counter irritation, we commonly begin with 

 a general bleeding of six, eight, ten, twelve, or even fifteen ounces, 

 according to the severity of the disease, and the constitution of 

 the woman. After this first venesection, if it appears to produce 

 some amelioration, it is repeated a second time, a third, or even a 

 fourth, at intervals more or less considerable, always remembering 

 that in this way the strength of the woman is rapidly exhausted. 

 "When the general bleeding can no longer be repeated with the hope 

 of obtaining any decided advantage from it, leeches may be applied to 

 the number of fifteen, twenty, thirty, forty, or fifty, behind the 

 ears, or on the neck, or even in the neighborhood of the vulva, 

 provided there should be any appearances of irritation or evident 

 congestion in the pelvis. Should the coma be very profound, and 

 blood not to be got except in very small quantity, scarified cups on 

 the nape of the neck, or on the mastoid apophyses, ought also to be 

 tried. As to bleeding from the temporal artery, or even from the 

 radial artery, proposed by some persons, I do not think that it de- 

 serves any preference over venesection: but which vein ought to be 

 opened? 



In the prevaling theory of blood-letting bleeding in the foot passes 

 for being essentially revulsive, while bleeding from the neck is rather 

 derivative, and that from the arm merely depletive; but these dis- 

 tinctions are scarcely justified by practice: Baudelocque has seen 

 bleeding from the saphena aggravate the affections that were inva- ' 

 riably diminished by opening a vein in the arm, and other practition- 

 ers have observed the inverse. In eclampsia the object is to disen- 

 gorge the vascular system, and when bleeding is deemed necessary, 

 I think it matters little whether it is taken from one vein rather than 

 another. If the cerebral congestion is fixed and too great, should 

 the opening of the jugulars appear to be indicated, leeches or cup- 

 ping might be regarded as preferable, considering that bleeding in the 

 neck is not always an easy nor even practicable matter, especially in 

 a person laboring under convulsions. 



